Surviving the stigma of mental illness
Film still from Frontline's "The Released." William Bryan Stokes, diagnosed as schizoaffective, being released from prison. Stokes is a cutter and has a long history of psychiatric hospitalizations starting at age 12.
Sitting across from Joni Schwager, executive director of Staunton Farm Foundation, we discussed one of the daunting challenges faced by those who work in the field of mental health: reducing the stigma associated with mental illness.
“Addressing stigma is important because stigma still exists,” Schwager explained. “Until we can eliminate stigma, it will continue to be a barrier for people to seek and receive treatment. People with behavioral illnesses are still discriminated in employment situations, getting life insurance, and serving in the armed forces, to name a few.”
Stigma is a concern that many in the field are so familiar with that it becomes an almost unspoken truth. But as Schwager explained to me, so many people have either experienced mental health issues themselves or know someone who has, that it shouldn’t be so taboo anymore. And she is right. It is gradually becoming a more casual topic, but with regard to more socially acceptable mental health issues such as depression or anxiety. But with more severe mental illnesses, such as schizophrenia or bi-polar disorder, these individuals not only face lifelong personal struggles but are often socially marginalized.
Established in 1937, Staunton Farm Foundation is dedicated to improving the lives of people who live with mental illness and/or substance use disorders.
When I asked Schwager what helps fuel the negative view of mental illness in America, she reminded me that the general public’s exposure to those suffering from mental illness is often one of extremes — e.g. the recent case of alleged cop killer Richard Poplawski being one potential example. We often hear about the crimes committed by the mentally ill, but rarely hear stories of how these same types of individuals have overcome great odds to live happy and productive lives.
This past April, Frontline aired a powerful documentary titled “The Released” that took an intimate look at how mentally ill criminal offenders struggle to survive outside the prison system. Many of the individuals profiled in the documentary relapsed following their release from prison. They would miss their medication, slip back into old habits, and end up experiencing a psychotic episode (e.g. go off meds and assault a police officer; break into a house believing Osama Bin Laden was inside; etc.) that would land them back in prison. An interesting element in the documentary was that it explored the vital and emerging role of mental health courts across the country. In mental health court, convicts with a history of mental illness are processed out of jail after serving their sentence, placed on parole, but then enrolled in a court-ordered mental health treatment program.
Schwager told me that in Pittsburgh, Pennsylvania (where Staunton Farm is headquartered), the county jail releases inmates at 11 p.m. — a time of night that can be extremely dangerous for individuals just released from prison. Especially when those individuals have a history of mental illness and/or addiction problems. And this specific example speaks to only one of the many challenges facing those living with mental illness.
“Our system is broke,” Schwager told me. “Behavioral health is segregated from all other forms of physical health services. Services are not integrated. We focus on symptoms, not prevention. Community resources are limited, especially housing. We don’t have a strong or adequate workforce. Public funding is not coordinated. Private funding rates of reimbursements are inadequate and co-pays are high. Depression, which is co-traveler with many physical illnesses, is not considered a chronic illness even though it is a leading cause of disability in people 15 to 44. On the positive note, with many illnesses, we know what works and there is data behind it. We have the knowledge and tools to help people, it’s the execution that’s the problem.”
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The challenge with this issue — and I admire journos who tackle it because it’s so un-sexy and scary — is you’ve conflated mental illness, at least here, with crime, which only stigmatizes those with mental illness further — as many people who are bi-polar have no criminal record.
And when Schwager spoke of prevention…of what? Of mental-illness created crime? Or of mental illness itself? As I understand bi-polar illness, there’s no preventing it, just medicating it as best you can after diagnosis. And the problem, as anyone intimate with it knows, is that many of them hate their meds, refuse to take them, and that’s it. Chaos ensues.
I also think, in a society where mental illness is so poorly understood or discussed (vs. alcoholism, for example) people are frightened to admit they suffer it, or have, even when they are fully functional.
Great point Caitlin. It wasn’t my intent to conflate mental illness with crime. But instead, point out that often the general public’s only exposure to severe mental illness is in these media scenarios we are all too familiar with (e.g. Poplawski shootings; Columbine; etc.). As a result, I believe that only deepens the stigma associated with severe mental illness.
And Schwager’s comment regarding prevention was in response to a question I asked her about the new challenges of mental health treatment in post-institutional America — and what are the pros and cons. While most everyone applauded the closure of state-run mental health facilities back in the 1970s (and for good reason), countless individuals with severe mental illnesses became homeless and often ended up in jail. These people are still struggling day-to-day.
And your last point is right on. I believe many people are simply frightened to admit they suffer from mental illness. And whether it’s due to social stigma, personal pride, shame, or any combination of factors, people need to feel they can discuss these problems so they can solve or at least address them. But creating the right social environment to nurture these needs is easier said than done.
In response to another comment. See in context »